Does Experience Influence the Performance of Neonatal and Pediatric Manual Hyperinflation?

• Published in: Respiratory care 2012-11, Vol.57 (11), p.1908-1913
• Main Authors: NOVAIS DE OLIVEIRA, Pricila Mara, AUGUSTO ALMEIDA-JUNIOR, Armando, CRUZ BRESCIANI ALMEIDA, Celize, GONCALVES DE OLIVEIRA RIBEIRO, Maria Angela, DIRCEU RIBEIRO, José
• Format: Article
• Language: English
• Subjects: Adult; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Care and treatment; Child; Child, Preschool; Children; Clinical Competence; Cross-Over Studies; Diseases; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Equipment and supplies; Experience; Female; Humans; Infant; Infant, Newborn; Influence; Intensive care medicine; Male; Medical sciences; Middle Aged; Reproducibility of Results; Respiration, Artificial - standards; Respiratory Mechanics; Respiratory therapy; Respiratory Therapy - standards; Respiratory tract diseases; Statistics, Nonparametric; Ventilators, Mechanical
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.01511

Manual hyperinflation (MH) is used to improve mucociliary clearance and alveolar expansion in mechanically ventilated patients. Despite the popularity of MH, studies with adults have shown considerable variability in the results from its use. This study assessed if professional training on the application of MH influences its performance. An experimental study was conducted with physiotherapists, including 11 with previous professional experience (experienced) and 11 without previous experience (inexperienced). They applied MH in a test lung model using self-inflating bags in 2 sizes (infant and pediatric) from 3 manufacturers (Hudson, Laerdal, and JG Moriya). The test lung simulated the lung mechanics of a newborn and a pediatric patient in 2 different clinical situations: at normal and reduced compliance. The professionals were instructed to perform MH as described in the literature. Measurements of inspiratory volume, peak inspiratory pressure, peak inspiratory flow, and peak expiratory flow were recorded using a pneumotachograph in each condition. The delivered peak inspiratory flow was higher in the experienced group (P = .03) than in the inexperienced group. This result was observed in both neonatal and pediatric self-inflating bags. There was no difference in the parameters delivered between the experienced and inexperienced groups. The experienced and inexperienced groups were similar in their overall MH performance; the only difference was the observation of the highest PIF in the results from the experienced group.